Best Medical Aids in South Africa Cover Breast Reduction
Do Medical Aids Cover Breast Reduction in South Africa revealed.
We verified the best medical aids in South Africa that cover breast reductions.
This is a complete guide to the best medical aids that cover breast reduction in South Africa.
In this in-depth guide you’ll learn:
- 👉🏿 What is a Breast Reduction?
- 👉🏿 Which medical aids cover breast reduction surgery in South Africa?
- 👉🏿 Do you get free breast reduction surgery in South Africa?
- 👉🏿 Which medical aids cover plastic surgery in South Africa?
So if you’re ready to go “all in” with the best medical aid that covers breast reduction in South Africa, this guide is for you.
Let’s dive right in…
Best Medical Aids in South Africa Cover Breast Reduction (2025)
- Discovery Medical Aid – Covers 80% on Breast Reduction on Comprehensive
- Bankmed – Is a scheme benefit on Comprehensive
- Compcare Medical Scheme – Covers 80% on its higher plan
📌Note: Contact the Medical Scheme directly to get 100% clarity. Information on breast reduction is very limited.
Introduction to Medical Aid Support & Coverage of Breast Reduction
👉 In recent years, breast reduction has emerged as one of South Africa’s most sought-after forms of cosmetic surgery, but breast reductions and other forms of cosmetic surgery are typically not covered by medical aids unless the surgeon can demonstrate that the procedure is absolutely essential to the patient’s health.
👉 In South Africa, the majority of medical aids for breast reduction surgeries fall into one of these three categories: medical aids that do not cover the cost of the procedure, medical aids that cover the cost of the procedure in full or in part, and medical aids that make decisions on a case-by-case basis after consulting with clinical experts.
👉 In most cases, breast reduction surgery is not covered by any of the available medical aids. Every medical aid has its own set of protocols and requirements to follow. Any procedure that involves plastic surgery in South Africa must adhere to stringent guidelines for it to be covered by insurance.
👉 A significant number of women and medical professionals are dissatisfied with the red tape that medical aids have imposed on a variety of plastic surgery procedures, including breast reductions, to pay for them. Breast reductions, in the opinion of these women and their doctors, should be regarded as procedures that are required for medical treatment, regardless of whether or not medical aids share their perspectives on the matter.
👉 During a breast reduction procedure in plastic surgery, the surgeon will remove some of the patient’s excess breast tissue. The stringent guidelines that medical aids have for procedures in plastic surgery that are both cosmetically desirable and medically necessary, will determine as to whether or not your medical aid will cover the cost of this procedure.
👉 A petition that was started by Breast Reduction Support SA and is addressed to the Council of Medical Aids and the department of health has received over 50,000 signatures from individuals who are interested in having their voices heard.
👉 When it comes to the vast majority of medical assistance programmes, providing sufficient financial justification for the cost of plastic surgery procedures like breast reduction is essential. In addition, even if the plan states that it will pay for the breast reduction surgery, you may still be required to provide a detailed justification for the medical necessity of the procedure. This justification will include relevant images, doctor’s reports, and your medical record.
👉 Women who have extra breast tissue often suffer from a variety of unpleasant physical symptoms, including pain in the back and neck, wheezing, and chest tightness.
👉 The operation is typically carried out under general anaesthesia, and its duration ranges anywhere from two to three hours on average. Breast reduction surgery can cost anywhere from R 55,000 to R 72,000. This price range is determined by the surgeon as well as the length of the procedure. The cost of anaesthesia, the fees charged by the hospital, the fees charged for consultation, and any fees charged by the assistant or surgeon are all included.
👉 Because all medical aid schemes in South Africa take a similar stance on breast reduction surgery, it appears to be a controversial point at this time.
👉 If you are a woman considering clinically indicated breast reduction surgery, take heart in the fact that doctors from APRASSA (Association of Plastic, Reconstructive, and Aesthetic Surgeons of Southern Africa) are advocating for you.
READ more about Breast Uplift Procedure (Mastopexy): Enhancing Form and Confidence
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Best-Known Medical Aids in South Africa & Their Coverage of Breast Reduction
👉 In most cases, payment for plastic surgery will only be covered by a medical aid plan if doing so is regarded as being required for medical reasons.
👉 If you and your attending physician can verify that a procedure is both medically necessary and will either repair or maintain normal body function, then the majority of medical aid schemes in South Africa will cover all or part of the costs associated with the surgical procedure, depending on the level of cover you have purchased.
👉 For instance, medical aids may provide coverage for the costs of rhinoplasty to correct a deviated septum, breast reduction surgery to alleviate postural backache or stress on the spine, or breast reconstruction surgery after a full or partial mastectomy.
👉 Even in cases where medical aid programmes are willing to cover the costs of cosmetic surgery, there are still many restrictions in place.
Breast medical procedures in South Africa:
- ✅ Breast Uplift Procedure (Mastopexy)
- ✅ Breast Reduction
- ✅ Breast Reconstruction with Latissimus Dorsi Flap
- ✅ Breast Reconstruction with Implant or Tissue Expander
- ✅ Breast Reconstruction with Abdominal Tissue Flap
- ✅ Breast Augmentation (Breast Implants)
- ✅ Excision Biopsy of a Breast Lump
👉 You will be required to provide a comprehensive justification for the necessity of the surgery, which should include pertinent photographs, reports from doctors, and medical records.
👉 The stance of well-known medical aids in South Africa is discussed below.
1. Discovery Medical Aid
Overview
👉 Discovery Health Medical Scheme (DHMS) is a registered open medical scheme, which means that anyone can join as long as they adhere to the Scheme’s rules and regulations. It is most likely the largest open medical scheme in South Africa.
👉 The Discovery Health Medical Scheme provides more than 20 different choices for health plans, each of which includes limitless coverage for private hospital care as well as a range of other benefits that can be tailored to your preferences and your financial situation.
👉 You will have access to a wide variety of benefits, care programmes, and services that will ensure that you can receive the highest quality medical care whenever it is required, and your doctor will be reimbursed accordingly.
👉 Discovery asserts that its monthly premiums payable by members are, on average, much lower than the contributions that other South African medical schemes demand for the same level of coverage.
👉 Vitality is the company’s wellness initiative in which members are invited to participate. The programme provides a range of incentives and benefits to inspire members to lead a healthy lifestyle.
Who Manages Discovery Medical Aid?
👉 The Discovery Health Medical Scheme is an independent non-profit entity governed by the Medical Schemes Act and regulated by the Council for Medical Schemes.
👉 The Scheme is owned by its members, and it is run by an independent Board of Trustees. It is administered by a separate company, Discovery Health (Pty) Ltd, an authorised financial services provider.
Discovery Medical Aid Plans that cover breast reduction.
👉 Discovery offers a wide variety of option plans to members, that range from the most comprehensive private healthcare cover to affordable basic plans where members can get cost-effective private healthcare cover when they make use of a set but extensive network of providers.
👉 Members can choose from the following medical aid plans that cover breast reduction:
👉 The top Executive Plan offers customers the most extensive cover for in-hospital and day-to-day benefits, as well as extended chronic medicine cover and an unlimited Above Threshold Benefit.
👉 Covers up to 80% of the procedure.
👉 This series of plans provide comprehensive day-to-day cover and in-hospital cover to members, as well as extended chronic medicine cover and an unlimited Above Threshold Benefit.
👉 Covers up to 80% of the procedure.
Breast Reduction Benefits under Discovery Medical Aid Option Plans
👉 Discovery Medical aid provide “medical support for the conservative management of macromastia”, as stated in its rules.
👉 DHMS maintain that it has funded funds breast reduction surgery for members on its higher plans who have a specific clinical need for these procedures for many years.
👉 The medical aid however does not pay for this kind of surgery where it is solely for aesthetic purposes. With other medical aids, it considers all cosmetic surgery as “a General Scheme Exclusion for open schemes in South Africa”.
👉 It is interesting though that plastic surgeons find that breast reduction is seldom done for cosmetic reasons. In the majority of cases, and despite what the schemes may say, it is needed by the candidate due to health reasons.
👉 If a member can prove a medical necessity, Discovery says the reduction surgery can be funded under its Executive and Comprehensive plans (except Classic Smart Comprehensive plan), but only if the patient falls within the fund’s selection criteria.
How Much Are Discovery Medical Aid Monthly Premiums?
| 🔎 Plan | 💴 Contributions Range (Main) ZAR | 💵 Contributions Range (+ Adult) ZAR | 💶 Contributions Range (+ Child) ZAR | 💷 Medical Savings (Up to) | 💴 Annual Threshold (ZAR) | 💵 Above Threshold (ZAR) | 📈 PMB Diagnosis | 📉 Chronic Conditions |
| 🥇 Executive Plan | 11,430 | 11,430 | 2,185 | R34,284 (Main) R34,284 (+1 Adult) R6,552 (+1 Child) | R39,440 (Main) R39,440 (Adult) R7,480 (Child) | Unlimited | 271 | 27 |
| 🥈 Comprehensive Series | 7,945 – 9,298 | 7,337 – 8,793 | 1,855 – 1,856 | R27,876 (Main) R26,364 (+1 Adult) R5,568 (+1 Child) | R32,250 (Main) R32,250 (Adult) R6,160 (Child) | R35,000 (Main) R35,000 (Adult) R8,500 (Child) | 271 | 27 |
| 🥉 Priority Series | 4,981 – 5,796 | 3,917 – 4,571 | 1,989 – 2,318 | R17,376 (Main) R13,704 (+1 Adult) R6,948 (+1 Child) | R25,400 (Main) R19,090 (Adult) R8,460 (Child) | R19,370 (Main) R13,820 (Adult) R6,770 (Child) | 271 | 27 |
| 🏅 Saver Series | 2,898 – 4,535 | 2,187 – 3,577 | 1,163 – 1,817 | R10,872 (Main) R8,580 (+1 Adult) R4,344 (+1 Child) | None | None | 271 | 27 |
| 📌 Core Series | 2,507 – 3,652 | 1,887 – 2,882 | 1,006 – 1,461 | No MSA | None | None | 271 | 27 |
| 📌 Smart Series | 1,350 – 2,822 | 1,350 – 2,227 | 1,127 – 1, 350 | No MSA | None | None | 271 | 27 |
| 📌 Keycare Series | 1,184 – 3,687 | 1,184 – 3,687 | 361 – 986 | No MSA | None | None | 271 | 27 |
What Is the Waiting Period for Discovery Medical Aid’s Benefits?
👉 Discovery Health Medical Scheme’s general waiting period is 3 consecutive months and the condition-specific waiting period is 12 consecutive months.
How to Claim for Discovery Medical Aid Benefits
👉 You can submit a claim fast and easily in the following ways:
- ➡️ Scan and upload your claims on the website.
- ➡️ Scan and email your claims to [email protected].
- ➡️ Use the Discovery app on your smartphone. If the claim has a QR code, scan the QR code or alternatively take a photo of the claim from within the app.
- ➡️ You can also submit your claims by post.
2. Bankmed
📌 Note: The comprehensive plan might cover breast reduction. Contact Bankmed directly for more clarity.
For self-help enquiries:
Try our easy-to-use App, telephonic or web-based facilities to obtain or request information and to update personal details without having to speak to an agent.
• 📞 Telephonic self-help facility
0800 Bankmed (0800 226 5633) – log in with your
membership number and ID number.
• ✔️ Web-based self-help facility
www.bankmed.co.za – sign in with your username
and password; if you haven’t registered before you
will be prompted to register the first time you sign in.
• ✔️ Bankmed mobi site m.bankmed.co.za
• ✔️ Bankmed Mobile App
Download the Bankmed Mobile App to your Smartphone or feature phone and follow the prompts. You may download the App from the different App stores, or visit the Bankmed website www.bankmed.co.za for instructions.
3. CompCare Medical Aid
📌 Note: The ExecuCare / ExecuCare Plus plan might cover breast reduction. Contact CompCare directly for more clarity.
Contact details:
You can contact CompCare customer support through the following channels:
- ✅ You can call their customer service center at 0861 227 322 from Monday to Friday between 8 am and 5 pm.
- ✅ You can email them at [email protected] for general inquiries or [email protected] for member-specific inquiries.
- ✅ You can fill out their online contact form on their website at https://compcare.co.za/contact-us/.
- ✅ You can reach out to them through their social media channels, including Facebook and Twitter.
Frequently Asked Questions
Can You Join a Medical Aid Just to Benefit for a Breast Reduction?
No, you cannot join a medical aid to benefit for a breast reduction. While anyone that qualifies to become a member of an aid, can join, medical aids do not necessary pay for reduction procedures.
Are There Medical Aids That Cover Breast Reduction?
Yes, there are medical aids that may, in certain circumstances, pay for breast reduction providing that the candidate can provide medical prove that it is not for cosmetic purposes.
How Much Does a Breast Reduction Cost at a Private Hospital Without Medical Aid?
Breast reduction surgery can cost anywhere from R 55 000 to R 72 000.
Does Medical Insurance Cover the Cost of Breast Reduction?
No, medical insurance does not cover the cost of breast reduction since it is often seen as a procedure done by choice.
Can You Have Medical Aid & Medical Insurance at the Same Time to Cover Breast Reduction?
You can have medical aid and medical insurance at the same time, but it will not necessarily mean that your breast reduction will be paid for.
